I’ve been researching vitamin D(3) for years. Since COVID-19 came crashing into our lives, I’ve circled back to D3 looking for new clues and findings specifically related to COVID-19. At this time, there seems to be enough data to support recommending supplementation with vitamin D for immune support – for just about everyone. Here’s more on what, why and how.
For My Fellow Science Nerds
Vitamin D is a fat-soluble vitamin that is naturally present in very few foods, added to others, and available as a dietary supplement. It is also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol. (NIH National Institutes of Health Office of Dietary Supplements Vitamin D Fact Sheet for Health Professionals)
Vitamin D is a steroid hormone. We call it a vitamin to identify it as something we can’t manufacture internally (or enough of it). Vitamin D controls 100s of genetic activations so it’s critical for preventing a host of disease processes by insuring optimal genetic activation and protein synthesis.
Vitamin D works to prime our innate immune system so we can fight off viruses, cold, flu and other nasal respiratory infections. Beyond the immune system, it is critical to regulating the absorption of calcium from the G.I. tract from food or supplements, plays a beneficial role in hormone mediated cancer prevention along with metabolic, heart and bone support. Vitamin D helps to sensitize cell receptors and regulate the balancing of other steroid hormones.
“Some of the more recently recognized non-classical actions of vitamin D include effects upon cell proliferation and differentiation as well as immunologic effects resulting in an ability to maintain tolerance and to promote protective immunity.” (Journal of Investigative Medicine, Vitamin D and the Immune System, Cynthia Aranow, Investigative M.D. August 2011)
Where do you source your vitamin D and how much are you getting? The answer can help you determine whether you should supplement with vitamin D3.
From the Sun: A quick Q and A
1. Do you get 30 minutes of direct sunlight between the hours of noon and 2 pm daily (without the use of sunscreen)?
2. Are you fair skinned?
3. Do you do live in a place that gets full sun exposure all year round?
From food: The highest vitamin D containing foods are (in order of international units of vitamin D greatest to least): wild salmon, fresh herring, sardines, cod liver oil, mushrooms and fortified foods including milk and dairy products, milk substitutes, cereal and orange juice. The highest containing foods (wild caught salmon being the only food that provides a full RDV of vitamin D at 988 internationl units for 3.5 ounces of salmon) are not foods that are necessarily “safe” to eat everyday (in the case of fish, because of mercury and toxic load). So getting adequate dietary vitamin D is a little bit of a long shot.
Do you belong to a low vitamin D risk factor group?
While it’s not impossible to get enough vitamin D from direct sunlight and / or your food supply, there are people who are at greater risk for vitamin D deficiency. And they are: vegans, vegetarians, the elderly, individuals who are lactose intolerant and/or all PEOPLE OF COLOR.
MAKING IMPORTANT COVID CONNECTIONS
In my own years of looking at D3, I’ve found study after study showing sub optimal levels of D3 in people who had specific types of hormone mediated cancers (i.e. prostate, colon, breast). That led me to a collection of data showing significantly higher mortality rates among people of color who succumbed to their illness, even when they received the same treatment at the same time as whites / lighter skinned people.
COVID FINDINGS: In post mortem blood analysis currently underway on various populations (race, ethnicity), one of the most compelling common factors among those who died = low blood serum levels of vitamin D
As COVID-19 took over the first half of 2020, it became clear that the COVID-19 mortality rate is disproportionately higher among people of color. Taking population-density risk factors off the table, the biggest common denominator we’re left with is this: people with darker skin tone are about twice as likely (than white/light skinned people) to have low levels of vitamin D. BECAUSE… people with more melanin in their skin have a natural barrier (good for reducing risk of skin cancer) to sun absorption (aka vitamin D from the sun).
With few exceptions, I encourage my clients to consider supplementing with vitamin D3. Especially, clients with darker skin pigmentation, clients living in northern states and clients who are not getting 20-30 minutes of daily sun exposure between noon and 2pm (without the use of sunscreen), when the sun is at an angle that casts your shadow shorter than your body (no joke). Let’s face it, that’s just about all of us.
SUPPLEMENT GUIDELINES:
At the more conservative end of the scale published reports support the definition of sufficiency, serum levels of 25-hydroxyvitamin D [25(OH)D] greater than 30 ng/mL (75 nmol/L). To achieve this, most people need vitamin D supplementation ranging from 600 to 2000 IU/day; consumption up to of 5000 international units (IU) per day of vitamin D is reported as safe.
Although light-skinned individuals need 1000 IU/day of vitamin D, elderly and dark-skinned individuals are likely to need approximately 2000 IU/day to maintain serum 25(OH)D levels greater than 30 ng/mL.
Other vulnerable patients, such as the obese, those who have undergone bariatric surgery, and those with gastrointestinal malabsorption syndromes, may require higher doses of vitamin D to maintain normal serum levels and be healthy - – Clinical Education. Org Michael Ash “So How Much Vitamin D Do I Need?” March 2012.
CRITICAL CO-FACTOR
MAGNESIUM IS A FUNDAMENTAL CO-FACTOR FOR THE BODY’S UTILIZATION OF VITAMIN D3.
I’ll spare you the crash course in the role magnesium plays in vitamin D activation and function (your welcome). But, this is so important to note because… as a country, whether you’re rich, poor, black, white, female, male, non-binary, young, medium, old or in-between, we all share the tendency toward magnesium deficiency. Why is that you ask…
Top soil erosion! Our soil is depleted - which has severely depleted our food supply of magnesium - which has depleted us. So, as you continue to read, remember that you will want to introduce either a magnesium supplement and/or make sure you’re starting off with a good base of magnesium-rich foods for a week or two before beginning any vitamin D3 supplementation protocol. This will help lay the foundation for D3 activation. Unlike vitamin D3, there are plenty of good Mg food options. You can also supplement. Note: I used to suggest transdermal magnesium as the fastest and easiest way to boost magnesium (i.e. Epsom salt bath, mineral absorption directly through the skin) but recent research brings into question the efficacy of this method so, for now, go with food, or supplemental Mg, or both. (Mg supplements can vary, have questions on this bit, leave a comment)
Magnesium rich foods include leafy greens, bananas, nuts, seeds, yogurt, grains and cereals, beans, legumes, tofu, some fatty fish AND DARK CHOCOLATE…BONUS!
Key Considerations for Supplementing with Vitamin D3
Dosage - As stated above – the range for adults is about 600 – 1,000 International Units per day and double that if you have brown or black skin tone.
Take with high(er) fat meal of the day - vitamin D is fat soluble, it needs fat in order to be absorbed into the body, always take it with food and schedule it with your highest fat containing meal of the day.
Magnesium is an essential co-factor for the efficiency of vitamin D. If you are magnesium deficient, you won’t absorb and utilize the vitamin D (in sun, supplement or food forms). Magnesium rich food include green leafy veggies, nuts, seeds, dairy, some poultry and meats. Pumpkin seeds are the highest magnesium containing food commonly available.
More is NOT better: vitamin D is a fat soluble vitamin absorbed in the body with the help of magnesium (co-factor) and it competes for receptor availability with other critically important fat soluble nutrients like vitamin A. Please, don’t over-do it.
Hot Flash Sufferers: If you’re living with hot flashes, vitamin D3 can exacerbate these vasomotor episodes. If you’ve ever had a hot flash, you know you don’t want another one. If you’re in one of the vitamin D deficiency risk groups, rely on dietary sources and / or low dose supplementation of vitamin D3 (i.e. 200 – 400 IUs per day). You may need to tweak as you go. If you’d like help with this, please contact me at https://www.betsy@betsycoxhealth.com
People with controlled auto immune disease: vitamin D3 revs up the immune system, for folks with an already overactive immune system, this is counter-productive. However, vitamin D3 can be useful if you have chronic infection / inflammation that’s driving your disease. If this is something you’d like to discuss, please contact me directly at: https://www.betsy@betsycoxhealth.com
Know your levels: Physicians now widely acknowledge blood serum levels of vitamin D within a series of ranges correlates with improved health. If your last lab work didn’t include blood analysis of vitamin D, ask for this the next time you have blood drawn.
What to look for on your lab report: According to the Institute of Medicine, serum concentration of 25(OH)D is the best indicator of vitamin D status. Persons are at risk of vitamin D deficiency at serum 25(OH)D concentrations <30 nmol/L (<12 ng/mL). Some are potentially at risk for inadequacy at levels ranging from 30–50 nmol/L (12–20 ng/mL). Practically all people are sufficient at levels ≥50 nmol/L (≥20 ng/mL); 50 nmol/L is the serum 25(OH)D level that covers the needs of 97.5% of the population. Serum concentrations >125 nmol/L (>50 ng/mL) are associated with potential adverse effects.
Final Thoughts
I so rarely recommend vitamin supplementation for people I’m not working with directly that writing this blog gave me pause. There’s a lot to consider and “do no harm” is the bedrock of EVERY decision I make as a health coach and culinary educator. That said, I do support supplementation with vitamin D3 when taken responsibly, especially now and particularly for at risk groups. It could literally be a life saver. I encourage you to reach out with questions or comments should you need more guidance or information. And as always, I wish you good health!
With Love in the Time of COVID
Betsy